CT Could Stand in for Full Autopsy in Some Cases

Action Points

Explain to interested patients that a minimally invasive post-mortem examination using CT scans, CT angiography, and biopsies may serve as an alternative to traditional autopsy in certain cases.

Note that the approach cannot detect a change in the color or texture of an organ, an important observation during an autopsy, and is more time-consuming.

A minimally invasive post-mortem examination using CT scans, CT angiography, and biopsies may serve as an alternative to traditional autopsy in certain cases, a small study found.

The radiologic approach correctly identified the cause of death in 18 of 20 bodies for which circumstances indicated a natural death, Stephan Bolliger, MD, of the University of Bern in Switzerland, and colleagues reported in the November issue of the American Journal of Roentgenology.

"In light of increasing objections of the next of kin toward an autopsy, and the necessity for medical examiners to assess the manner and cause of death, we think that the minimally invasive procedure described here may present a viable compromise in selected cases," the researchers wrote.

"A close collaboration between pathologists and radiologists is imperative for the correct sampling and diagnostic assessment and, therefore, for the success of such an undertaking."

Post-mortem CT scans have been shown to be useful for diagnosing most forms of traumatic death, although they have limited ability to accurately image vascular and organ pathologic abnormalities. Angiography has been introduced to address that shortcoming, but it too has limitations, including the inability to examine histologic changes to tissues.

Bolliger and his colleagues compared a minimally invasive technique that combined CT scans, angiography, and targeted biopsies with traditional autopsy with histologic analysis, using 20 consecutive bodies with a probable natural death. Half died at home, five died in a clinical institution, two died in vehicles without a crash, and one each died while jogging, on a mountain, and at work.

For the minimally invasive approach, biopsies were taken of the heart and lungs in every case, with additional biopsies taken of suspicious regions identified on CT.

All bodies then underwent a full forensic autopsy.

The major findings and causes of death were largely consistent between the two approaches, although there was disagreement on the cause of death in two cases.

In the first, the minimally invasive approach underestimated the severity of cardiac ischemia by missing some contraction band necroses, resulting in a vague diagnosis of cardiac arrest rather than the autopsy-confirmed diagnosis of MI.

In the other -- a body that was found lying in the snow in the mountains -- there was complete disagreement between the two types of examination.

Both techniques identified extensive tuberculosis, and the cause of death was listed as cardiac arrest due to tuberculosis-associated cachexia using the radiologic findings.

However, the full autopsy also found discoid muscle necrosis in the iliopsoas muscles and gastric erosions, both of which indicate an accidental death by hypothermia.

The researchers noted that the biopsies were taken by a person with little forensic experience, which might explain why the iliopsoas muscles were not biopsied.

"This shortcoming highlights the necessity of a close collaboration between pathologists and radiologists in performing the proper examinations and thus arriving at the correct conclusions," they wrote.

The main advantages of the radiologic method are fewer objections from family members who do not want their relative to have an invasive autopsy, and less exposure to infectious agents.

But there are drawbacks as well. The minimally invasive examination cannot detect a change in the color or texture of an organ, an important observation during an autopsy.

In addition, the radiologic examination is more time-consuming -- an experienced pathologist can perform a full autopsy in a shorter amount of time.

"However, we believe that, with more experience and better equipment, these examinations will become more rapid and cheaper, very much like the development of laparoscopic surgical procedures," Bolliger and his colleagues wrote.

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